The ringing hospital phone startled me. As an intern I had spent many nights in the hospital lounge. On this particular night I had just fallen asleep, when a nurse, needing help with a very agitated, distraught and tearful patient, decided to call me for advice. After listening to the situation I decided to go to our patient's bedside and see if I could help.

Earlier that day we had operated on this lovely and eloquent middle aged woman to remove a suspicious tumor of the ovary, which was discovered during a routine gynecological exam. What we found surprised us all.

The tumor was malignant and had spread to many areas of her abdomen, including her liver. We did what we could, but each of us around the operating table that morning knew that our patient would more than likely die in the next year and there was little that we could do to change that.

It was now up to the physician to begin the process of explaining and informing both the anxious family in the waiting room and then, as soon as possible when she awoke, the patient.

After completing the surgery, my teacher, the patient's physician, asked me to follow him from the operating room to the waiting room. Seeing us come down the hall, the family quickly surrounded us, their faces revealing fatigue, anxiety and fear.

It was then that I watched with amazement and respect how the physician took them to a quiet room and then, with considerable skill and careful attention to words and phrases as well as incredible sensitivity, explained what was found, what could be done, all that despite the ominous findings, there still was hope. I remember clearly that, as we left the room he turned to me and said "Always leave hope in the room, it's the best medicine we have."

Later that same day, when the patient was awake and alert, her nurse informed me she was ready to be told what happened. Standing next to the bed in the recovery room and listening to the physician explain, I was once again impressed. Ever so slowly he gave details in such a way as to be understood easily, while explaining what he had found and what were the next steps. Whenever possible, he reassured. Finally, he took her into his arms and told her how sorry he was that she had to go through this. After we left her bedside he turned to me and said "The only words that work here I'm sorry. Don't try to say more.

Moments later, over a cup of coffee, in a somewhat pensive mood he continued to explain that he felt our job was to help our patients understand what was happening to them with sensitivity and to help them through the stages of dying that most individuals go through if allowed the time.

He emphasized that we had to understand the importance of these stages and know that patients need to deal with each stage on their own time schedule and in their own way. Our job as physicians was to support them and be very good listeners, but always leave hope.

That lesson helped me as I sat on the patient's bed that early morning, holding her hand and listening to her grief and disbelief pour forth. It was reassuring to me as a young physician to know that I did not need to say anything more. Just listening would work and that when it was time for me to say something I would know what to say.

I learned much about medicine that day. I learned how a doctor should handle the probably of death without overlooking the possibility of life and I have tried to pass along this information to young students of medicine. Being a good physician is more than diagnosing the end of one's life, it is also helping patients with life until that life comes to an end.


by Dr. Frank Boehm in July 1996.